After emergency treatment, employees can only be reimbursed if the medical expenses exceed 2,000 yuan, and the reimbursement ratio is 50%. Retired workers under the age of 70 can be reimbursed for medical expenses exceeding 1300, and the reimbursement ratio is 70%; Retired workers over 70 years old can be reimbursed for medical expenses exceeding 1300 yuan, and the reimbursement rate is 80%. The maximum amount of medical insurance reimbursement for employees of these three groups is 20,000 yuan.
Employee medical insurance reimbursement is as follows:
1, according to the first payment method, 80% of medical expenses (90% for essential drugs) will be paid in hospitals with essential drugs, and 60% will be paid in hospitals with essential drugs; Secondary hospitals pay 58%; Tertiary hospitals pay 45%;
2. According to the second payment, the first-level hospital pays 85% (90% for basic drugs), the second-level hospital pays 70%, and the third-level hospital pays 60%;
3. Minor residents and special groups enjoy the treatment of secondary payment of medical insurance;
4. The Qifubiaozhun for reimbursement of hospitalization medical expenses is 300 yuan, a first-class hospital, 500 yuan, a second-class hospital and 700 yuan, a third-class hospital. Malignant tumor patients who have been hospitalized for chemotherapy and radiotherapy for many times in a medical insurance year will only be deducted once.
Insured workers in designated community health service centers or township hospitals in accordance with the provisions of the outpatient medical expenses, paid by the general outpatient co-ordination fund according to the proportion of 50%. There is no deductible for the general outpatient expenses incurred by the insured workers in the basic medical institutions that implement the national basic drug system; In other primary medical institutions, the minimum payment standard was reduced from 40 yuan to 30 yuan. The reimbursement limit for the first-class general outpatient service was raised from 60 yuan to 80 yuan; The second payment was made in 200 yuan.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.